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This is the Emergency Medical Form, Liability and Commitment Waiverrequired for all participants.

 

AKNOWLEDGEMENT & ASSUMPTION OF RISKS, RELEASE OF LIABILITY AND INDEMNITY AGREEMENT 

WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS.  READ IT CAREFULLY  

Every Person MUST read, complete and sign this waiver before participating in program and/or camp and/or event activities as offered by  AFM Uxbridge Inc. (the "Organization").

The following waiver of all claims, release from all liability, assumption of all risks and other terms of this agreement are entered into by the "Athlete" (the Athlete of 18 years or older or the Parent/Guardian of a minor Athlete) with and for the benefit of AFM Uxbridge Inc., it's directors, officers, employees, volunteers, coaches, officials, business operators, agents, and site property owners or Occupiers (the "Organization").  The term "Occupiers" is defined in accordance with teh definition of occupiers contained in the occupier's liability legislation of the province or territory i which the Activities are provided by the Organization.

  1. "Activities" includes, but is not limited to, sports, fitness activities, functions, instruction, use of the facilities, participating in programs, competitions, competition programs and events, and services provided to the Athlete by the Organization whether occurring in or outside the Province of Ontario.
  2. I am aware that there are inherent and significant risks, dangers and hazards ("Risks") associated with participation in the Activities.  I am aware that those Risks include but are not limited to the potential for serious personal injury and/or death caused by any Activities or any condition of the facility, equipment or environment or collision with,or negligence of other persons.  I understand the risks may be relative to the Athlete's state of fitness and health (physical, mental and emotional), and to the awareness, care and skill with which the Athlete conducts themself while participating in the Activities.
  3. I freely accept and fully assume all responsibility for all Risks and possibilities of personal injury, death, property damage or loss resulting from my participation in Activities.  I agree that it is not possible for the Organizaton to make the Activities completely safe.  I accept these Risks and agree to the terms of this agreement even if the Organization is found to be negligent or in breach of any duty of care or any obligation to me in my participation in Activities.
  4. I understand that, as part of the Athlete's participation in Activities, photographs or video may be taken by persons associated with the Organization (AFM Uxbridge Inc.), or any media that may be present.  By executing this agreement, I agree to allow the Athlete's image to be used for any media purposes including, but not limited to, promotions and advertisements.
  5. In consideration of the Organization (AFM Uxbridge Inc.) accepting my registration and for other good or valuable consideration, I hereby agree, on behalf of myself, and on behalf of my heirs, next of kin, executors, administrators and assigns (collectively my "Legal Representatives"):
  • To waive all claims that I have or may have in the future against the Organization, and to release and forever discharge the Organization from all liability for all personal  injurydeath, property damage, expense or loss that I or my next of kin may suffer (either directly or indirectly), resulting from the Athletes participation in Activities and due  to any cause, including but not limited to negligence (failure to use such caer as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or error of judgement of the Organization; and    
  • to hold harless and indemnify the Organization from all actions, proceedings, claims, damages, costs (including court costs and costs on a solicitor and client basis), demands, and lieabilities of whatsoever nature or kind arising out of or in any way connected with the Athletes participation in Activities.  

      6. ​​I agree that this agreement is goverened by the laws of the Province of Ontario.  I hereby irrevocebly submit to the exclusive jurisdiction of the ourts of the Province of Ontario.  Any litigation to enforce this agreement must be instituted in the Province of Ontario.

      7. I confirm that I have had sufficient time to read and understand each term in this agreement in its entirety, and have agreed to the terms freely and voluntarily.  I understand that this agreement is binding on me and my Legal Representatives.​

Medical Treatment Release

I, the undersigned parent or guardian, do hereby acknowledge, understand and agree that in participating in cheerleading/training, there is a possibility of physical injury/illness (both acute and permanent) and that my son/daughter is assuming risk of such injury/illness by his/her participation. I assume full responsibility for my son/daughter’s participation. 

In order that my son/daughter/I may receive the necessary medical treatment in the event of injury or illness, I hereby authorize the Air Force Mavericks Gym Staff/Coaches to seek and/or facilitate medical treatment for my son/daughter for such illness or injury sustained during time in the gym. Furthermore, The Organization (AFM Uxbridge Inc.), it's directors, officers, employees, volunteers, coaches, officials, business operators, and agents will not be held responsible for any injury or illness incurred while my son/daughter is in the gym.  

Border Crossing Consent

I, the parent/guardian of the participating Athlete am giving my full consent for my daughter/son to travel into the United States with the "Organization" and their Coaching Staff to participate in ALL of the season events for the duration of their participation in the program. 

I give full responsibility for my daughter/son to the coaching staff of the Organization. 

Registration Contract

I have read the Air Force Mavericks Information package, the rules and regulations, pricing structure and understand it's contents.  I understand the responsiblity my Athlete is undertaking by becoming a registered member of the Organization.  I agree to fully suport the Athlete and will encourage them to fulfull their commitment.  

I also understand that by signing this contract, I am bound to not withhold my Athlete's participation in this program as a form of punishment as I realize that it also punishes their team and the entire Organization's program.  Furthermore, I understand that being an Athlete with the Organization is a commitment on the part of the parent/guardian as well.  I realize that when representing the Organization I will conduct myself with decorum and in a responsible manner.  I agree to refrain from inebriation as a result of alcohol or marijuana use when participating or attending any Organization affiliated event or in associated hotels or other event related spaces.

I understand tht any Athlete or parent who does not abide by the rules and regulations contained in this contract, who is consistently negative, or acts in a manner that jeopardizes the name and reputation of the Organization and/or it's program, will be subject to removal with no refund.  

I have read and understood the Organization's Refund Policies and understand that should my Athlete leave the program outside of the refundable period, that I am responsible for all outstanding committed program costs as outlined in the published 2019-2020 Air Force Mavericks Information Package.  Failure to pay the account in full will result in the account being turned over to a collection agency.

Athlete's acknowledgement of responsibilities

The Athletes agrees to participate in the programme, related events and activities of the "Organization".

AND UNDERSTANDS AND AGREES WITH THE FOLLOWING STATEMENTS:

1.) My parents and I believe that I am physically, emotionally and mentally able to fully participate in this programme and as such have given their unqualified permission for me to take part.

2.) I am familiar with, and will follow, all the applicable rules for participation in this programme.

3.) My equipment is mechanically fit and suitable for my use in this programme.

4.) I understand that at all times during my participation in this programme, I have sole responsibility for my safety.

5.) I understand that should I not attend the designated 'final four' practices leading up to a competition for any reason other than a family death or a severe and/or contagious illness, I will relinquish my right to compete at that competition and forfeight any competition costs. 

If, during the course of my participation in this programme:

(a)  I learn or become aware, of a change in my health, physical, emotional or mental condition, or

(b)  I feel unsafe or threatened for any reason, or

(c)  I notice anything unsafe about the programme,

I WILL IMMEDIATELY STOP PARTICIPATING and INFORM THE NEAREST OFFICIAL.

Please sign here, and again on the pages that follow:

December 10, 2019

 

First Athlete's Name

First Name*

Last Name*
First Athlete's Date of Birth*
I certify that I am 18 years of age or older
First Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
First Athlete's Signature*
Second Athlete's Name

First Name*

Last Name*
Second Athlete's Date of Birth*
Second Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Second Athlete's Signature*
Third Athlete's Name

First Name*

Last Name*
Third Athlete's Date of Birth*
Third Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Third Athlete's Signature*
Fourth Athlete's Name

First Name*

Last Name*
Fourth Athlete's Date of Birth*
Fourth Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Fourth Athlete's Signature*
Fifth Athlete's Name

First Name*

Last Name*
Fifth Athlete's Date of Birth*
Fifth Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Fifth Athlete's Signature*
Sixth Athlete's Name

First Name*

Last Name*
Sixth Athlete's Date of Birth*
Sixth Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Sixth Athlete's Signature*
Seventh Athlete's Name

First Name*

Last Name*
Seventh Athlete's Date of Birth*
Seventh Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Seventh Athlete's Signature*
Eighth Athlete's Name

First Name*

Last Name*
Eighth Athlete's Date of Birth*
Eighth Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Eighth Athlete's Signature*
Ninth Athlete's Name

First Name*

Last Name*
Ninth Athlete's Date of Birth*
Ninth Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Ninth Athlete's Signature*
Tenth Athlete's Name

First Name*

Last Name*
Tenth Athlete's Date of Birth*
Tenth Athlete's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Tenth Athlete's Signature*
Athlete's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. I am the legal guardian of the above athlete (or am a member that is 18 years of age). I verify that fee charts have been reviewed, explained and understood and I agree to pay all applicable team fees and agree to all terms stated in the payment and refund policies as outlined in the Air Force Mavericks Information Package.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent Name *

Primary Parent Mobile Phone Number *

Secondary Parent Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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